News
- Critical Access Hospitals: Download Your FY 2025 PEPPER
- Clinical Laboratory Fee Schedule Preliminary Gapfill Rates: Submit Comments by July 13
- Clinical Diagnostic Laboratory Reporting: Are You an Applicable Lab?
- Hospitals: Accurately Report Allogeneic Hematopoietic Stem Cell Acquisition Costs
- Nursing Homes: Payroll Based Journal Manual & FAQ Updates
- National Physical Fitness & Sports Month
Events
MLN Matters® Articles
Publications & Multimedia
From Our Federal Partners
News
Critical Access Hospitals: Download Your FY 2025 PEPPER
CMS released the FY 2025 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) for critical access hospitals. PEPPERs help hospitals review their billing data to make sure claims are accurate. They can use them to:
- Spot billing patterns that may need improvement
- Identify areas that may need audits or closer monitoring
- Find Diagnosis-Related Groups that may be under-coded or over-coded
- Track areas where patient stays are getting longer
How to get your PEPPER: Authorized officials (AOs), access managers (AMs), and staff end users (SEUs) can download their organization’s report from the PEPPER Portal.
How to become an SEU:
- Sign in to the Identity & Access (I&A) System using your existing NPPES or PECOS credentials
- Request the PEPPER business function under your organization
- Your request must be approved by your AO or AM:
- See the I&A System Quick Reference Guide and FAQs
- Contact the External User Services Help Desk for assistance
Review the User Guide for more information.
Clinical Laboratory Fee Schedule Preliminary Gapfill Rates: Submit Comments by July 13
CMS published preliminary gapfill rates (ZIP) for the Clinical Laboratory Fee Schedule (CLFS). Send your comments on these rate recommendations to clfs_inquiries@cms.hhs.gov by July 13. Visit the CLFS Annual Public Meetings webpage for more information.
Clinical Diagnostic Laboratory Reporting: Are You an Applicable Lab?
Watch Is My Lab an Applicable Lab? and find out if you meet the definition of an applicable laboratory under the Clinical Laboratory Fee Schedule (CLFS). If so, you must report your data by July 31, 2026.
See the CLFS & PAMA Reporting and Resources webpage for more information.
Hospitals: Accurately Report Allogeneic Hematopoietic Stem Cell Acquisition Costs
If you’re a subsection (d) hospital and you furnish inpatient allogeneic hematopoietic stem cell (Allo-HSC) transplants, you must accurately report Allo-HSC acquisition costs on your Medicare Cost Report:
- Use Form CMS-2552-10, Worksheet D-6 from the Provider Reimbursement Manual, Part 2 (PDF)
- Only include charges for the Medicare recipient or expected recipient in your hospital
- Maintain an itemized statement that identifies all costs defined in 412.113(e)(2)
You must keep records for each patient receiving Allo-HSC acquisition services (donor or recipient). For all donor sources, you must identify the prospective recipient, recipient identifier, and MBI for Medicare patients.
If you perform Allo-HSC acquisition services for another hospital, National Marrow Donor Program, or similar organization, you must seek reimbursement from them. Don’t include the associated charge on Worksheet D-6. Medicare only pays for services you furnish to Medicare patients.
More Information:
- Medicare Claims Processing Manual, Chapter 3 (PDF), section 90.3.1.A.2
- FY 2021 Inpatient Prospective Payment System final rule
- Further Consolidated Appropriations Act, 2020, Division N, Title 1, Section 108
Nursing Homes: Payroll Based Journal Manual & FAQ Updates
CMS uses staffing data to accurately and effectively gauge its impact on the quality of care in nursing homes. Use the Payroll-Based Journal (PBJ) system to submit your staffing information. Review the PBJ Policy Manual (PDF) and FAQs (PDF) (updated June 2025) to learn about policy updates.
Note: These updates provide additional details about existing policies; they don’t reflect changes to policy or expectations. All updates are in red italics.
More information:
- Staffing Data Submission PBJ webpage
- Email NHStaffing@cms.hhs.gov with questions about these updates
National Physical Fitness & Sports Month
Encourage your patients to get moving toward better health. Physical activity is essential to maintaining good health, reducing the risk of many chronic diseases, and supporting overall mental well-being (Office of Disease Prevention and Health Promotion (ODPHP)).
CMS recently finalized a new HCPCS code (G0136) for a physical activity and nutrition risk assessment as an add-on code for evaluation and management (E/M) visits (every 6 months) or the annual wellness visit.
More Information:
- Annual Wellness Visit webpage
- E/M Services (PDF) booklet
- Medicare & Mental Health Coverage (PDF) booklet
- ODPHP Physical Activity Guidelines for Americans webpage
- Dietary Guidelines for Americans
Events
Clinical Laboratory Fee Schedule Annual Public Meeting – June 10
Wednesday, June 10 from 10 am to 4:30 pm ET
Baltimore, MD or virtual
Register by May 29 to present or attend in person.
More Information:
- Public Meeting Regarding New and Reconsidered Clinical Diagnostic Laboratory Test Codes for the Clinical Laboratory Fee Schedule for Calendar Year 2027 notice
- CLFS Annual Public Meetings webpage
MLN Matters® Articles
Clinical Laboratory Fee Schedule & Clinical Laboratory Improvement Amendments HCPCS Codes, Waived Tests & Reasonable Charge Payments: July 2026 Quarterly Update
Learn about updates (PDF), effective July 1, 2026:
- Annual and quarterly Clinical Laboratory Improvement Amendments edits and new waived test updates
- New and deleted CPT codes
Publications & Multimedia
Clinical Laboratory Fee Schedule: Data Reporting Template & NPI TIN Association Videos
Watch new training videos on Clinical Laboratory Fee Schedule (CLFS) reporting:
Visit the CLFS & PAMA Reporting and Resources webpage for more information.
From Our Federal Partners
2026 Hantavirus Outbreak: Testing for Potential Infection
CDC issued a Health Alert Network Health Update to inform clinicians and health departments about testing available for patients with suspected hantavirus infection to include Andes virus. CDC first issued a Health Advisory about this outbreak on May 8, 2026. Hantaviruses are a group of viruses that typically spread to people who come in contact with sylvatic rodents. These viruses can cause severe illness or death in humans. Andes virus, a type of hantavirus endemic in South America, is the only type of hantavirus that is known to spread from person to person. Several other New World hantaviruses are endemic to the United States and are not transmissible from person to person. New World hantaviruses can cause hantavirus pulmonary syndrome, a potentially serious disease that can cause damage to the lungs.
Read the full Health Update, including recommendations for clinicians.
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